Your Pregnancy Matters
Birth control after childbirth: Long-term options for new moms
September 29, 2020
After you have a baby, birth control will probably be the last thing on your mind. That's why we recommend planning for contraceptives around the time of your 36-week prenatal visit.
During the COVID-19 pandemic, many prenatal and postpartum appointments are conducted through video visits, the latter of which typically occurs six to 12 weeks after delivery. But ovulation often resumes before this time – which means a patient can get pregnant before she is ready.
Many women choose long-term contraceptive options so they don't have to worry about taking a daily pill or relying on natural birth control (ovulation tracking) while caring for a newborn.
We typically recommend three types of birth control options for women who want to avoid pregnancy after childbirth: the Depo Provera shots, which last about three months; long-acting reversible contraceptive (LARC) devices, which are effective up to 10 years; and tubal ligation, which is considered permanent.
Each of these can be given in the delivery room or before you go home with your new baby, and there’s no extra recovery time if you get a device or procedure. Any patient who is done having babies or would prefer not to get pregnant again right away might be a good candidate for these effective, long-term options. Patients who relate to these factors may benefit most:
- Limited access to ongoing Ob/Gyn care. If it's tough to get to the doctor, it will likely be difficult to start short-term or long-term contraceptives.
- Unlikely to attend the postpartum visit. We absolutely recommend attending this important appointment. However, some patients forget, have trouble arranging transportation, or cannot arrange childcare for older kids.
- Likely to resume sex before the postpartum visit. Approximately 40% to 57% of women resume sex prior to six weeks after delivery. You can get pregnant during this time, even if you are breastfeeding and haven't had your first post-delivery period.
- Facing reproductive coercion: Women whose partners tamper with their birth control might be inclined to choose an inconspicuous long-term option.
Your birth control method is your choice – your Ob/Gyn specialist can give you information to help in the decision process. We recommend discussing your preferences with your provider prior to heading to the delivery room. That way, the care team will be prepared to give you what you need.
Here's a quick run-through of each type of long-term birth control to help you start the conversation with your provider.
3 birth control options you can get after delivery
1. Tubal ligation: Lasts forever
This form of long-term contraception, also known as "getting your tubes tied," involves a procedure that closes off the fallopian tubes, preventing eggs from moving down the tubes and combining with sperm.
According to the American College of Obstetricians and Gynecologists (ACOG), this form of permanent sterilization is more than 99% effective within the first year after surgery. You will still have a period, and there is a slightly increased risk for ectopic pregnancy (when a fertilized egg implants somewhere outside the uterus). However, that risk is less than if you used no birth control at all.
To do the procedure immediately after delivery, the surgeon will make a one-inch incision in or near your belly button. Because of the larger uterine size after delivery, the tubes are nearby. The doctor can tie off and remove a small segment of the tube in just a few minutes.
Some women choose to wait until the day after delivery to have the procedure, after their baby's physical exams are complete. Knowing their baby is healthy makes them feel more comfortable about having their tubes tied.
It's important to note that, for most women, tubal ligation is permanent. While surgery is available to try reversing it, there is no guarantee it will work. Make certain you are done having babies before committing to this procedure.
2. LARC devices: Effective up to 10 years
This category includes intrauterine devices (IUDs) and implants placed under the skin, such as Nexplanon.
LARCs are more than 99% effective and are reversible. They're also one of the easiest reversible contraceptives to use long term. The Contraceptive CHOICE Study showed that nearly 90% of LARC users keep using their device after a year, compared with less than 60% of patients who choose short-term methods such as the pill.
To place an implant after delivery, the doctor will make a small, relatively painless incision in the inner arm and slide a matchstick-sized tube that contain hormones under the skin. The hormones control ovulation, similar to how the birth control pill works, but you don't have to do anything to keep it working.
To place an IUD, the doctor will insert a T-shaped device made of copper (no hormones) or plastic (contains hormones) into your uterus. The device is about two inches long and can be placed through the vagina, with no incisions required. It can also be placed following a C-section, before the uterine incision is completely closed.
Having an IUD placed after delivery makes the recovery process easier – you won't have additional discomfort because you've just had a baby, and you might be numb during the insertion if you had an epidural or cesarean section. If you choose to have one placed later, you may experience mild discomfort during insertion and bleeding or spotting for a few weeks after placement.
With an IUD, there is an increased chance that the device will move out of place as your uterus and cervix change after delivery. However, approximately 70% to 90% of immediate postpartum placements are successful, and more than 80% of these patients continue using their IUD six months later.
If you want an implant or IUD, talk with your doctor before you go into labor. They'll make sure the hospital has the device you want on hand.
Related reading: Would an IUD or birth control implant work for me?
3. Depo Provera: Lasts up to three months
Also known as "the shot," Depo Provera is an easy, though not as long-lasting, birth control option. The doctor will give you one hormone injection in the arm, which will help control ovulation for up to three months. At the end of that time, you'll need to get another injection.
The shot is more than 99% effective if you stay on schedule. If you are late getting an injection, you'll need to use backup birth control, such as condoms, to prevent pregnancy.
There has been some concern about whether the hormone progesterone in the shot interferes with breast milk quality or quantity. However, there is no compelling data to suggest that it does. Depo Provera is considered safe for breastfeeding moms.
Related readings: Self-serve birth control? The future of OTC contraceptives
A few closing thoughts
Before choosing your preferred birth control method, it's a good idea to check your insurance coverage for inpatient and outpatient methods.
When it comes to birth control after delivery, we encourage you to talk with your Ob/Gyn provider about your options. You have the right to ask questions, get answers, and be heard. We're not here to tell you what to do – our role is to help you achieve health and happiness with your family-planning goals.